Interventions for keeping groups running smoothly

Our previous article outlined the nuts and bolts of 11 group agreements, with commentary intended to enhance the therapeutic value of group work.1 This article offers interventions for addressing challenging behaviors by group members that can dishonor those group agreements. Some amount of overlap exists among the interventions for these nine group-challenging behaviors:

1. Returning from break with food items on the table, beverages other than water placed on the floor underneath the table, cell phone in possession, or holding other items not allowed because of the distractions they create.

The group facilitator might say, “OK, it looks like our break time is up, but before we start everyone go ahead and do a self check-in. Ask yourself, ‘Am I honoring the group agreements?’” This allows group members to assume ownership of knowing what the group agreements are, to take responsibility for being more mindful of the agreements, and to engage in self-correcting behaviors. Members typically will catch themselves dishonoring the group’s agreed-upon protocol; those who don’t are usually caught and corrected by other members honoring the group norms.

A sign at the entrance of the room where we meet states, “Please leave food or beverages other than water outside group room.” Under the sign is a trash can and table to accommodate a holding place for such items until the end of the session. If this is unnoticed or not honored, the facilitator makes a verbal request to honor the message if other members of the group have not already brought it forward.

2. Cross-talking.

When necessary, the facilitator simply stops all activity to bring awareness to cross-talking. Once the session is paused, the group facilitator could directly ask one of the cross-talkers to explain to the group the message they are sending by speaking over others or speaking out of turn. This provokes reflection and prompts those engaging in cross-talking to comment on its impact.

Those who are speaking over others might say something along the lines of, “I wasn’t listening,” or “I felt that what I had to say directly addressed something someone else was saying and had to say it when I did.” The facilitator should take this input and help guide it to a productive place for the group.

It also is important to ask group members to offer their interpretations of cross-talking to help them understand the varied meanings that inform the behavior, regardless of the cross-talker's intent. This powerful intervention holds group members accountable for their behavior. Group members might construe cross-talking as indicating that the cross-talker does not care, believes what he/she has to say is more important, or lacks empathy.

This is probably one of the most effective ways to eliminate this distraction long-term, as members provide feedback and offer comments on how they are affected by cross-talking; as cross-talkers learn how their behavior shapes the group’s opinion of them; and as cross-talkers become increasingly aware of their behavior by reflecting on the group’s reactions, ultimately taking a deeper look at their behavior.2 The session is then less likely to return to cross-talking.

3. Getting up and leaving the group session.

We have not yet encountered a client leaving without first asking the facilitator or the group to understand their desire to leave. But what we might suggest is that anyone who leaves be allowed to experience whatever outcomes a missed session generates. The group facilitator also might say, “All behavior carries with it pleasure, cost and benefits.” Asking the member what those are and leaving it at that usually suffices to get the member to reconsider whether leaving is worth it.

4. Packing up before the session ends (sometimes as much as 15 minutes early).

The group facilitator can engage the entire group in a mindfulness activity that is fruitful for delivering the message that leaving early dishonors the group.

The facilitator begins the exercise by inviting the group to play a game. This usually will grab the group’s attention. Tell members to sit silently with their eyes closed for the next minute and instruct each person to raise his/her hand at the point when 60 seconds have passed on the clock. The aim of the game is to see who can produce the most accurate prediction. The group facilitator times the exercise, recording the time at which each member raises his/her hand to guess.3 When time is up, check in with members to see what they learned and felt. This brief group intervention usually expands group members’ capacity for patience.

The group facilitator also could encourage members to create time mantras, such as “I am not the Wicked Witch of the West and time is not water. So I won’t melt if I have to wait another minute.” Members can make up their own “thought stoppers” to help forestall impatience. The facilitator also may explain to the group that members might avoid feeding their “problem of immediate gratification” (or PIG), or relay what Marlatt explained using this memorable abbreviation:

“The pig is an animal with a huge appetite; it stands for the “problem of immediate gratification.” The pig shows up, grunting, 'I’m hungry. I’m really having a craving. Come on, feed me.' If you respond, 'Okay, if that’s what you need, I can give it to you,' then what happens? The pig gets bigger and gains more control. When your pig is saying, 'Give me, give me, give me,' we suggest you talk to the pig. Have a moment of contact.”4

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